The nucleus accumbens--possible site of antipsychotic action of neuroleptic drugs?

The role of the D3 dopamine receptor and its partial agonist cariprazine in patients with schizophrenia and substance use disorder

INTRODUCTION

Comorbidity of substance use disorder (SUD) with schizophrenia, referred to as dual disorder (DD), significantly increases morbidity and mortality compared to schizophrenia alone. A dopaminergic dysregulation seems to be a common pathophysiological basis of the comorbidity.

AREAS COVERED

This article reports the current evidence on the role of dopamine dysregulations in DD, the pharmacological profile of cariprazine, a partial agonist of D3 and D2 dopamine receptors, and first clinical observations that may support its usefulness in the therapy of DD. PubMed/MEDLINE was searched for the keywords 'cariprazine,' 'schizophrenia,' 'dual disorder,' 'dopamine,' and 'dopamine receptor.' Preclinical and clinical studies, and reviews published in English were retrieved.

EXPERT OPINION

Although the management of DD remains challenging, and the evidence for pharmacologic treatments is still unsatisfactory, cariprazine may be a candidate medication in DD due to its unique mechanism of action. Preliminary clinical experiences suggest that cariprazine has both antipsychotic and anticraving properties and should be considered early in patients with DD.

Multifaceted effect of chlorpromazine in cancer: implications for cancer treatment

Since its discovery in 1951, chlorpromazine (CPZ) has been one of the most widely used antipsychotic medications for treating schizophrenia and other psychiatric disorders. In addition to its antipsychotic effect, many studies in the last several decades have found that CPZ has a potent antitumorigenic effect. These studies have shown that CPZ affects a number of molecular oncogenic targets through multiple pathways, including the regulation of cell cycle, cancer growth and metastasis, chemo-resistance and stemness of cancer cells. Here we review studies on molecular mechanisms of CPZ’s action on key proteins involved in cancer, including p53, YAP, Ras protein, ion channels, and MAPKs. We discuss common and overlapping signaling pathways of CPZ’s action, its cancer-type specificity, antitumorigenic effects of CPZ reported in animal models and population studies on the rate of cancer in psychiatric patients. We also discuss the potential benefits and limitations of repurposing CPZ for cancer treatment.

Use of T1-weighted/T2-weighted magnetic resonance ratio images to elucidate changes in the schizophrenic brain

INTRODUCTION

One leading hypothesis suggests that schizophrenia (SZ) is a neurodevelopmental disorder caused by genetic defects in association with environmental risk factors that affect synapse and myelin formation. Recent magnetic resonance imaging (MRI) studies of SZ brain showed both gray matter (GM) reduction and white matter (WM) fractional anisotropy reduction. In this study, we used T1-weighted (T1w)/T2-weighted (T2w) MRI ratio images, which increase myelin-related signal contrast and reduce receiver-coil bias.

METHODS

We measured T1w/T2w ratio image signal intensity in 29 patients with SZ and 33 healthy controls (HCs), and then compared them against bias-corrected T1w images.

RESULTS

Mean T1w/T2w ratio signal intensity values across all SZ GM and WM voxels were significantly lower than those for the HC values (analysis of covariance with age, gender, handedness, and premorbid intelligence quotient as nuisance covariates). SZ mean WM T1w/T2w ratio values were related to Global Assessment of Functioning (GAF) scores and were inversely related to the positive psychotic symptoms of the Positive and Negative Syndrome Scale. Voxel-based analysis revealed significantly lower T1w/T2w ratio image signal intensity values in the right ventral putamen in SZ GM. T1w image intensities did not differ between the SZ and HC groups.

CONCLUSIONS

T1-weighted/T2-weighted ratio imaging increased the detectability of SZ pathological changes. Reduced SZ brain signal intensity is likely due to diminished myelin content; therefore, mapping myelin-related SZ brain changes using T1w/T2w ratio images may be useful for studies of SZ brain abnormalities.

Resting-state functional connectivity of the nucleus accumbens in auditory and visual hallucinations in schizophrenia

Both auditory hallucinations (AH) and visual hallucinations may occur in schizophrenia. One of the main hypotheses underlying their occurrence involves the increased activity of the mesolimbic pathway, which links the ventral tegmental area (VTA) and the nucleus accumbens (NAcc). However, the precise contribution of the mesolimbic pathway in hallucinations across various sensory modalities has not yet been explored. We compared the resting-state functional connectivity (rs-FC) of the NAcc among 16 schizophrenia patients with pure AH, 15 with both visuoauditory hallucinations (VAH), and 14 without hallucinations (NoH). A between-group comparison was performed using random-effects ANCOVA (rs-FC of the bilateral NAcc as the dependent variable, groups as the between-subjects factor, age and Positive and Negative Syndrome Scale scores as covariates; q(false discovery rate [FDR]) < .05). Compared to the NoH group, the AH group exhibited significantly enhanced NAcc rs-FC with the left temporal superior gyrus, the cingulate gyri, and the VTA, whereas the VAH group, compared to the AH group, exhibited significantly enhanced NAcc rs-FC with the bilateral insula, putamen, parahippocampal gyri, and VTA. The strength in rs-FC between the NAcc and the VTA appeared to be positively associated with the presence of hallucinations, but the NAcc FC patterns changed with the complexity of these experiences (ie, 0, 1, or 2 sensory modalities), rather than with severity. This might support the aberrant salience hypothesis of schizophrenia. Moreover, these findings suggest that future clinical and neurobiological studies of hallucinations should evaluate not only the global severity of symptoms but also their sensorial features.

Animal Modeling and Neurocircuitry of Dual Diagnosis

Dual diagnosis is a problem of tremendous depth and scope, spanning many classes of mental disorders and addictive drugs. Animal models of psychiatric disorders studied in addiction paradigms suggest a unitary nature of mental illness and addiction vulnerability both on the neurocircuit and clinical-behavioral levels. These models provide platforms for exploring the interactive roles of biological, environmental and developmental factors on neurocircuits commonly involved in psychiatric and addiction diseases. While suggestive of the artifice of segregated research, training, and clinical cultures between psychiatric and addiction fields, this research may lead to more parsimonious, integrative and preventative treatments for dual diagnosis.

Motivational responses to natural and drug rewards in rats with neonatal ventral hippocampal lesions: an animal model of dual diagnosis schizophrenia

The high prevalence of substance use disorders in schizophrenia relative to the general population and other psychiatric diagnoses could result from developmental neuropathology in hippocampal and cortical structures that underlie schizophrenia. In this study, we tested the effects of neonatal ventral hippocampal lesions on instrumental behavior reinforced by sucrose pellets and intravenous cocaine injections. Lesioned rats acquired sucrose self-administration faster than sham-lesioned rats, but rates of extinction were not altered. Lesioned rats also responded at higher rates during acquisition of cocaine self-administration, and tended to acquire self-administration faster. Higher response rates reflected perseveration of responding during the post-injection "time-out" periods, and a greater incidence of binge-like cocaine intake, which persisted even after cocaine self-administration stabilized. In contrast to sucrose, extinction from cocaine self-administration was prolonged in lesioned rats, and reinstatement of cocaine seeking induced by cocaine priming increased compared with shams. These results suggest that neonatal ventral hippocampal lesions facilitate instrumental learning for both natural and drug rewards, and reduce inhibitory control over cocaine taking while promoting cocaine seeking and relapse after withdrawal. The findings are discussed in terms of possible developmental or direct effects of the lesions, and both positive reinforcement (substance use vulnerability as a primary disease symptom) and negative reinforcement (self-medication) theories of substance use comorbidity in schizophrenia.

Can antipsychotic drugs be classified by their effects on a particular group of dopamine neurons in the brain?

During the four decades that research has been carried out on antipsychotic drugs, a variety of methods have been used to study the effects of these compounds on dopamine neurotransmission. An important issue in this research was to find an explanation for the difference between "typical" and "atypical" antipsychotic drugs. The hypothesis that the beneficial properties and the motor side effects of antipsychotic drugs result from their effects on different groups of dopamine neurons has received considerable attention. Numerous researchers have tried to discover regiospecific actions of antipsychotic drugs in mesolimbic and in mesocortical dopamine neurons. An overview of these research attempts is presented here. Electrophysiological studies showed a selective action of atypical antipsychotic drugs on A10 dopamine neurons. It was found that chronic treatment with these compounds induced a preferential depolarisation block of the A10 neurons that project to the mesolimbic areas. The model represents certain clinical features of antipsychotic drug use and offers a possible explanation for the lack of extrapyramidal side effects of atypical antipsychotic drugs. Dopamine neurons projecting from A10 to the frontal cortex are also considered as a possible site of action of atypical antipsychotic drugs. Microdialysis studies have shown that certain atypical antipsychotic drugs selectively enhance the release of dopamine in the prefrontal cortex when compared with typical antipsychotic drugs. The finding that repeated treatment with antipsychotic drugs increased dopamine D(2) receptor binding in the frontal cortex confirms the significance of this brain area. These properties might indeed explain certain beneficial effects of atypical antipsychotic drugs such as improvement of cognitive dysfunction. However the effects of typical and atypical antipsychotic drugs in the frontal cortex could not be fully differentiated, which illustrates the difficulty of localising clinical effects of antipsychotic drugs in terms of regional dopamine neurons. Recently new insights into the mechanism of action of typical and atypical antipsychotic drugs have been published. Clinical positron emission tomography (PET) studies have indicated that a moderate dopamine D(2) receptor occupancy, probably combined with a high dissociation rate, might provide the optimal clinical conditions for an antipsychotic drug, without inducing extrapyramidal side effects. Moreover the efficacy of benzamides as atypical antipsychotic drugs suggests that low to moderate dopamine D(2) blockade is probably the most important-if not the only-criterion that determines "atypicality". Interestingly these new insights are based on PET studies of the human basal ganglia and not on the comparison of different brain areas. Apparently, according to this concept an ideal antipsychotic drug need not to act on a particular type of dopamine neurons, as it is the moderate dopamine D(2) receptor occupancy that determines the desirable clinical effects. It is concluded that both beneficial actions and side effects, of antipsychotic drugs might be dose dependently localised in A9 as well as A10 dopamine neurons.

Localization and pharmacological characterization of [3H]perospirone-binding sites in rat brain

1. The regional distribution and pharmacological property of binding sites for perospirone, an atypical neuroleptic, in rat brain were examined by an in vitro binding assay. 2. A high degree of [3H]perospirone binding was observed in the frontal cortex, caudate putamen, nucleus accumbens, olfactory tubercle, lateral septum, choroid plexus, hippocampus and entorhinal cortex. 3. In cortical membranes, the frontal cortex and nucleus accumbens, 1 nM [3H]perospirone bound predominantly to serotonin 5-HT2A receptors (about 40% of specific [3H]perospirone binding) rather than to dopamine D2 receptors. 4. About 60% of binding sites specifically labeled with 1 nM [3H]perospirone were D2 receptors and about 20% were 5-HT2A receptors in striatal membranes and the caudate putamen. 5. [3H]Perospirone interacted mainly with 5-HT1A receptors in hippocampal membranes and the lateral septum. 6. These results suggest that perospirone has a broad binding activity and that predominant occupancy of 5-HT2A receptors in mesocortical and mesolimbic structures might concern the atypical profile of perospirone as an antipsychotic drug.

Survey on the pharmacodynamics of the new antipsychotic risperidone

This review reports on the pharmacodynamics of the new antipsychotic risperidone. The primary action of risperidone is serotonin 5-HT2 receptor blockade as shown by displacement of radioligand binding (Ki: 0.16 nM), activity on isolated tissues (EC50: 0.5 nM), and antagonism of peripherally (ED50: 0.0011 mg/kg) and centrally (ED50: 0.014 mg/kg) acting 5-HT2 receptor agonists in rats. Risperidone is at least as potent as the specific 5-HT2 receptor antagonist ritanserin in these tests. Risperidone is also a potent dopamine D2 receptor antagonist as indicated by displacement of radioligand binding (Ki: 1.4 nM), activity in isolated striatal slices (IC50: 0.89 nM), and antagonism of peripherally (ED50: 0.0057 mg/kg in dogs) and centrally acting D2 receptor agonists (ED50: 0.056-0.15 mg/kg in rats). Risperidone shows all effects common to D2 antagonists, including enhancement of prolactin release. However, some central effects such as catalepsy and blockade of motor activity occur at high doses only. Risperidone is 4-10 times less potent than haloperidol as a central D2 antagonist in rats and it differs from haloperidol by the following characteristics: predominant 5-HT2 antagonism; LSD antagonism; effects on sleep; smooth dose-response curves for D2 antagonism; synergism of combined 5-HT2/D2 antagonism; pronounced effects on amphetamine-induced oxygen consumption; increased social interaction; and pronounced effects on dopamine (DA) turnover. Risperidone displays similar activity at pre- and postsynaptic D2 receptors and at D2 receptors from various rat brain regions. The binding affinity for D4 and D3 receptors is 5 and 9 times weaker, respectively, than for D2 receptors; interaction with D1 receptors occurs only at very high concentrations. The pharmacological profile of risperidone includes interaction with histamine H1 and alpha-adrenergic receptors but the compound is devoid of significant interaction with cholinergic and a variety of other types of receptors. Risperidone has excellent oral activity, a rapid onset, and a 24-h duration of action. Its major metabolite, 9-hydroxyrisperidone, closely mimics risperidone in pharmacodynamics. Risperidone can be characterized as a potent D2 antagonist with predominant 5HT2 antagonistic activity and optimal pharmacokinetic properties.

Occupancy of central neurotransmitter receptors by risperidone, clozapine and haloperidol, measured ex vivo by quantitative autoradiography

Risperidone (Risperdal) is a novel antipsychotic drug, with beneficial effects on both positive and negative symptoms of schizophrenia, and with a low incidence of extrapyramidal side effects (EPS). These particular properties have been attributed to the predominant and very potent serotonin 5-HT2 receptor antagonism of the drug combined with less potent dopamine D2 antagonism. In order to provide data on the degree to which various central neurotransmitter receptors are occupied in vivo, we performed ex vivo receptor occupancy studies with risperidone in comparison with clozapine and haloperidol in rats and guinea pigs. Various types of receptors, to which the compounds were known to bind to in vitro, were investigated precisely using receptor autoradiography in sections of the same rat brain except for histamine H1 receptors that were measured in the guinea-pig cerebellum. Risperidone (2 h after s.c. treatment) occupied 5-HT2 receptors at very low doses (ED50 = 0.067 mg/kg). Nearly full occupancy (> 80%) was achieved before H1, D2, alpha 1 and alpha 2 receptors became occupied (ED50 = 0.45, 0.66, 0.75 and 3.7 mg/kg, respectively). Clozapine displayed occupancy of H1 and alpha 1 receptors at low doses (ED50 = 0.15 and 0.58 mg/kg, respectively) and of 5-HT2, 5-HT1C, D2, alpha 2, cholinergic muscarinic and 5-HT1A receptors at higher doses (ED50 = 1.3, 1.8, 9.0, 9.5, 11 and 15 mg/kg, respectively). Haloperidol occupied D2 and alpha 1 receptors at low doses (ED50 = 0.13 and 0.42 mg/kg, respectively) and 5-HT2 receptors at a higher dose (ED50 = 2.6 mg/kg). Occupancy of receptor types occurred with similar ED50-values in various brain areas, e.g. D2 receptors in striatum and mesolimbic areas. The ED50-values for the ex vivo measured occupancy of 5-HT2 and D2 receptors were in good agreement with ED50-values for functional effects putatively mediated by these central receptors. The dose-dependent occupancy of D2 receptors proceeded more gradually with risperidone (slope in the caudate-putamen: 0.85) than with clozapine (slope: 1.44) or haloperidol (slope: 1.51). It has previously been suggested that partial D2 receptor occupancy may suffice to control the positive symptoms of schizophrenia, whereas higher D2 receptor occupancy would induce extrapyramidal symptoms (EPS). The dose ratio for high (75%) vs. low (25%) D2 receptor occupancy in the caudate-putamen, was 37.3 for risperidone, 8.4 for clozapine, and 7.9 for haloperidol.(ABSTRACT TRUNCATED AT 400 WORDS)

On dopaminergic modulation of temporal information processing

Temporal processing of durations in the range of seconds or more (i.e. time estimation) is cognitively mediated, whereas processing of brief durations in the range of milliseconds (i.e. time perception) appears to be beyond cognitive control and based on neural counting mechanisms. Although there is some evidence from animal and human studies suggesting that the internal timing mechanism underlying time perception is modulated by the effective level of brain dopamine, the findings are not conclusive. Therefore, the effects of pharmacologically induced changes in D2 receptor activity on temporal information processing were evaluated. In a double-blind design, either 3 mg of haloperidol, 150 mg of remoxipride, or placebo were administered in a single oral dose. Performance on time estimation was significantly impaired by both haloperidol and remoxipride as compared with placebo. Both drugs obviously affected cognitive mechanisms underlying temporal processing of durations in the range of seconds. On the other hand, only haloperidol produced a significant decrease in performance on time perception as compared with placebo and remoxipride, whereas the remoxipride and placebo groups did not differ significantly. The differential effects of haloperidol and remoxipride on performance on time perception suggest that D2 receptor activity in the basal ganglia may play a critical role in timing of brief durations in the range of milliseconds.

Late-onset schizophrenia: relationship to awareness of abnormal involuntary movements and tobacco addiction

Although schizophrenia usually emerges at mid to late-adolescence, it has been estimated that almost 20% of schizophrenic patients develop their first symptoms in mid to late life (late-onset schizophrenia). The biological characteristics that distinguish patients with early onset from those with late-onset schizophrenia have not been well delineated. A subgroup of neuroleptic-treated schizophrenic patients develops tardive dyskinesia (TD) and the majority of these patients are unaware of their movements. To investigate whether early and late-onset schizophrenic patients with TD could be differentiated on the basis of awareness of involuntary movements, we compared the prevalence of awareness of these abnormal movements in patients with early (N = 40) and late-onset (N = 15) schizophrenia. We found a significantly higher prevalence of awareness of involuntary movements in patients with late-onset schizophrenia as compared to those with an earlier age of onset (86.6% vs. 25.0%, p < .0001). In a second study, we investigated whether early and late-onset schizophrenia could be differentiated on the basis of dopamine functions in the mesolimbic system. Since tobacco addiction is mediated via limbic dopaminergic functions, we investigated the prevalence of tobacco addiction in patients with early (N = 51) and late-onset (N = 13) schizophrenia. We found a significantly lower prevalence of tobacco addiction in patients with late-onset schizophrenia as compared to those with an earlier age of onset (15.4% vs. 54.9%; X2 = 6.49; p < .01). Our findings support the notion that distinct pathophysiological mechanisms underlie the development of early and late-onset schizophrenia.

Interaction of antipsychotic drugs with neurotransmitter receptor sites in vitro and in vivo in relation to pharmacological and clinical effects: role of 5HT2 receptors

In the introductory section an overview is given of the strategies which have been proposed in the search for side-effect free antipsychotics. Special attention is paid to the role of predominant 5HT2 receptor blockade over D2 blockade. Whereas D2 receptor blockade seems to be essential for the treatment of positive symptoms of schizophrenia, it also underlies the induction of extrapyramidal side effects (EPS). Predominant 5HT2 receptor blockade may reduce the EPS liability and can ameliorate negative symptoms of schizophrenia. We further report a nearly complete list of neuroleptics that are on the European market and eight new antipsychotics that recently entered clinical trial, 5HT2 and D2 receptor binding affinity (Ki values) and the rank order in affinity for various neurotransmitter receptor subtypes are also discussed. For the eight new antipsychotics and for six reference compounds the complete receptor binding profile (including 33 radioligand receptor binding and neurotransmitter uptake models) is reported. Furthermore, for a series of 120 compounds the relative affinity for D2 receptors and D3 receptors (a recently cloned new dopamine receptor subtype) is compared. Finally, original findings are reported for the new antipsychotic risperidone and for haloperidol and clozapine on the in vivo occupation of neurotransmitter receptors in various brain areas after systemic treatment of rats or guinea pigs. The receptor occupation by the drugs was measured ex vivo by quantitative receptor autoradiography. The receptor occupancy was related to the motor activity effects of the test compounds (measurements were done in the same animals) and to the ability of the drugs to antagonize various 5HT2 and D2 receptor mediated effects. With risperidone a high degree of central 5HT2 receptor occupation was achieved before other neurotransmitter receptors became occupied. This probably co-underlies the beneficial clinical properties of the drug. Antagonism of the various D2 receptor-mediated effects was achieved at widely varying degrees of D2 receptor occupancy, from just about 10% to more than 70%. For therapeutic application it may be of prime importance to carefully titrate drug dosages. Antipsychotic effects may be achieved at a relatively low degree of D2 receptor occupancy at which motor disturbances are still minimal. With drugs such as risperidone that produce shallow log dose-effect curves, differentiation between the various D2 receptor mediated effects may be made more easily, allowing EPS-free maintenance therapy of schizophrenic patients.

Vitamin C in the treatment of schizophrenia

This report concerns a 37-year-old chronic schizophrenic patient who derived substantial benefit from the addition of ascorbic acid (vitamin C) to his neuroleptic treatment. The case highlights the potential usefulness of vitamin C as an adjunctive agent in the treatment of chronic schizophrenia.

Differential effects of amfonelic acid on the haloperidol- and clozapine-induced increase in extracellular dopac in the nucleus accumbens and the striatum

This study compares the effects of the nonamphetamine stimulant amfonelic acid on the increase in extracellular 3,4-dihydroxyphenylacetic acid (DOPAC) induced by haloperidol and clozapine in the nucleus accumbens and the striatum of anaesthetized rats. DOPAC was simultaneously recorded in both regions using differential pulse voltammetry with electrically pretreated carbon fibre electrodes. Amfonelic acid (2.5 mg/kg s.c.) did not alter basal striatal DOPAC but produced a significant reduction in extracellular DOPAC in the nucleus accumbens. Haloperidol (1 mg/kg s.c.) increased extracellular DOPAC in both regions. When amfonelic acid was injected 5 min before haloperidol, the increase in DOPAC was potentiated in both the nucleus accumbens and the striatum but with a greater effect in the striatum. Clozapine (30 mg/kg i.p.) increased extracellular DOPAC in both regions, an effect partially attenuated by amfonelic acid in both regions but to a greater extent in the striatum. When ritanserin (5 mg/kg i.p.), a serotonergic antagonist (5-HT-2), was co-administered with haloperidol, the potentiation by amfonelic acid of the increase in extracellular DOPAC induced by haloperidol was attenuated in both the nucleus accumbens and the striatum. The present results confirm that amfonelic acid can be used to discriminate neurochemically between haloperidol and clozapine in vivo. The effects of amfonelic acid on the neuroleptic-induced changes in extracellular DOPAC were greater in the striatum than the nucleus accumbens. These results further demonstrate that both neuroleptics increase dopamine metabolism in the two brain regions but by different mechanisms, supporting the view that the regulation of dopamine metabolism differs in the two regions.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of amfonelic acid to discriminate between classical and atypical neuroleptics and neurotensin: an in vivo voltammetric study

Previous ex vivo studies have shown that the non-amphetamine stimulant amfonelic acid potentiates the increase in DOPAC induced by classical but not by atypical neuroleptics. In the present study, we have demonstrated that this neurochemical model can be used to discriminate typical from atypical neuroleptics in vivo using differential pulse voltammetry with carbon fibre electrodes. The study also compared the effect of intracerebroventricular (i.c.v.) administration of neurotensin, on extracellular striatal DOPAC following amfonelic acid, with the effects of both classical and atypical neuroleptics. Saline or amfonelic acid (2.5 mg/kg s.c.) were administered; followed 5 min later by the classical neuroleptics haloperidol, perphenazine, or the atypical neuroleptics clozapine, thioridazine, or by neurotensin. After drug administration extracellular striatal DOPAC was recorded every 5 min for 90 min. Amfonelic acid did not alter basal striatal DOPAC but potentiated the increase in DOPAC induced by haloperidol (1.0 and 0.05 mg/kg s.c.) and perphenazine (10 mg/kg s.c.). Both clozapine (30 mg/kg i.p.) and thioridazine (20 mg/kg s.c.) increased extracellular DOPAC, but pretreatment with amfonelic acid prevented the increase in DOPAC produced by both drugs. Neurotensin (10 micrograms, i.c.v.), in a similar manner to the atypical neuroleptics, increased extracellular DOPAC in the striatum and the effect was prevented by amfonelic acid. The present study demonstrates that pretreatment with amfonelic acid is a valuable tool to discriminate between classical and atypical neuroleptics in vivo. The results also indicate that neurotensin in the presence of amfonelic acid has a profile similar to the atypical neuroleptics.

In vivo neurochemical and behavioural effects of intracerebrally administered neurotensin and D-Trp11-neurotensin on mesolimbic and nigrostriatal dopaminergic function in the rat

The effects of intracerebral application of neurotensin on the behavioural responses to peripheral dopamine agonist administration to rats, and on the levels of DOPAC voltammetrically determined in the striatum and nucleus accumbens of the anaesthetized rat have been examined. Bilateral application of neurotensin to the nucleus accumbens, like the neuroleptic haloperidol, inhibited the hyperactivity response to the dopamine agonist, n,N-propylnorapomorphine, but, unlike haloperidol, its bilateral intrastriatal application failed to reduce the degree of stereotyped behaviour induced by peripheral apomorphine injection. In the halothane-anaesthetized rat, neurotensin, when applied to the ventral tegmental area, stimulated DOPAC production in the ipsilateral nucleus accumbens, while its application to the substantia nigra did not affect striatal DOPAC levels significantly. Following its intracerebroventricular injection, however, DOPAC levels were considerably enhanced in both regions. The 11-D-tryptophan-substituted analogue of neurotensin potently mimicked the effects of the peptide itself in all studies. The findings of these investigations further confirm in vivo that the functional antagonism of dopamine by neurotensin is selective for the mesolimbic system, and that the effects of neurotensin can be correlated with reports on the regional distribution of its high-affinity binding sites in the rat brain.

Clozapine fails to prevent the development of haloperidol-induced behavioral hypersensitivity in a cotreatment paradigm

We have previously established that chronic cotreatments involving antimuscarinic agents and haloperidol attenuate the development of behavioral hypersensitivity without affecting dopamine receptor proliferation. The antipsychotic agent clozapine also has significant antimuscarinic activity and was coadministered with haloperidol in rats for 2 months to determine if it would similarly attenuate the development of hypersensitivity. Clozapine or chlorpromazine cotreatment, unlike thioridazine cotreatment, did not attenuate the development of haloperidol-induced behavioral hypersensitivity. Clozapine or thioridazine cotreatment also failed to prevent the development of haloperidol-induced D2 receptor proliferation, whereas chlorpromazine cotreatment enhanced D2 receptor proliferation relative to haloperidol-treated animals. Alterations in dopamine biochemistry in the striatum or nucleus accumbens could not explain this dissociation between behavioral hypersensitivity and dopamine receptor proliferation. It is therefore hypothesized that dopamine receptor proliferation is permissive for behavioral hypersensitivity and that factors in addition to alterations in dopamine function contribute to the expression of dopamine hypersensitivity states.

Chronic thioridazine treatment differently affects DA receptors in striatum and in mesolimbo-cortical systems

Chronic thioridazine administration (5 mg/kg for 22 days) caused both behavioral and dopamine (DA) receptor modifications in rats. After chronic thioridazine administration, a significant increase in both locomotion and stereotypies induced by apomorphine was observed. In particular, only sniffing increased significantly, whereas grooming behavior decreased and the number of rearings did not change. Autoradiographic data were consistent with the behavioral results. Chronic thioridazine caused an up-regulation of DA receptors both in the striatum and in the olfactory tubercle (O.T.). The striatal effect may account for the increase of stereotypies, whereas the effect in the olfactory tubercle may account for the increase in locomotion. An increase in DA receptors was also found in the medial (MCTX) and dorsal cortex (DCTX). However, a decrease in DA receptors appeared in the nucleus accumbens septi (NAS) and in the lateral cortex (LCTX). This decrease, selectively localized in the mesolimbic DA system, may represent the neurobiological substrate of the depolarization block observed in A10 neurons after chronic thioridazine treatment.

Thioridazine chronic administration: a behavioural and autoradiographic study

In rats the effects of chronic treatment with thioridazine (5 mg/kg orally administered for 22 days) were studied by means of behavioural supersensitivity to apomorphine and by means of dopamine (DA) receptors quantitative autoradiography. Locomotion and stereotypies induced by apomorphine increased after thioridazine chronic administration, whereas grooming behaviour decreased. Autoradiographic data showed an increase in DA receptors density both in the striatum and in the olfactory tubercle, to which the increase in stereotypies and locomotion could be respectively attributed. DA receptors increased also in the medial and dorsal frontal cortex. Moreover a decrease in DA receptors density appeared in the nucleus accumbens septi and in the lateral frontal cortex. Receptors decrease found in these regions might be associated with thioridazine-induced chronic inactivation of A10 DA neurons, to which the antipsychotic effect of the drug is attributed.

Selective dopamine D2 antagonist and prolactin response in acute schizophrenia--results from remoxipride studies. The Canadian Remoxipride Study Group

1. In a double-blind dose finding study prolactin was assessed at baseline and end of treatment in three groups of acute schizophrenics receiving low, intermediate and high doses of remoxipride as compared to a controlled group that received haloperidol. 2. Remoxipride only in high doses (300-600 mg daily) has produced a modest increase in prolactin levels at endpoint as compared to the much higher increase in prolactin secretion that accompanied haloperidol treatment. 3. The weak effects on prolactin as well as the previously reported low incidence of extrapyramidal side effects confirm the profile of remoxipride as a selective dopamine D2 antagonist with preferential effects on the mesolimbic and mesocortical tracts. 4. Male responders to either remoxipride or haloperidol treatment had significantly higher baseline prolactin levels regardless of dose and drug used. In females, there was no difference in baseline prolactin between responders and nonresponders.

Differences in dopamine release and metabolism in rat striatal subregions following acute clozapine using in vivo microdialysis

This study examined and compared the effects of acute clozapine administration over a range of doses on the release of dopamine (DA) and its metabolite 3,4-dihydroxyphenylacetic acid (DOPAC) in dorsolateral and fundus striata. Basal extracellular DA levels were significantly higher in the dorsolateral striatum. However, DOPAC levels were similar in both regions. Acute treatment with clozapine (40 mg/kg) was associated with an increase in extracellular dopamine in the dorsolateral striatum but not in the fundus. In contrast, an increase in extracellular DOPAC was seen in both regions following all doses of the drug; however, clozapine was more potent in the dorsolateral striatum than in the fundus. These results illustrate the functional heterogeneity of the striatum and in addition, indicate a possible dissociation between the effect of acute clozapine on DA release and DA metabolism.

Dopamine receptors in human brain: autoradiographic distribution of D2 sites

We have studied the detailed anatomical distribution of D2 receptors in human post mortem brain tissue using quantitative autoradiographic techniques. D2 receptors were labeled using the specific D2 agonist [3H]CV 205-502 and the antagonist [3H]spiroperidol. The pattern of D2 receptor distribution observed with the two ligands was very similar. The highest densities were found in the nucleus caudatus, putamen, nucleus accumbens and olfactory tubercle followed by the substantia nigra, where D2 receptors were mainly concentrated in the pars compacta. Lower but still significant densities were associated with the lateral part of the globus pallidus and CA1 and CA3 fields of the hippocampus. The medial part of the globus pallidus, the dentate gyrus and the amygdala showed low to very low densities of D2 receptors. Almost negligible amounts of binding were observed in the olfactory bulb, diencephalon, brainstem, cerebellum and most parts of the neocortex. Our results are comparable with previously reported localizations of D2 receptors in the human and rat brain. We also report the lack of the so-called spirodecanone binding sites in the human brain. The localization of D2 receptors is compared with the distribution of D1 receptors.

Actions of dopamine antagonists on stimulated striatal and limbic dopamine release: an in vivo voltammetric study

1. Fast cyclic voltammetry at carbon fibre microelectrodes was used to study the effects of several dopamine antagonists upon stimulated dopamine release in the rat striatum and nucleus accumbens. 2. In both nuclei, stimulated dopamine release was increased by D2-receptor-selective and mixed D1/D2-receptor antagonists. The D1-selective antagonist SCH 23390 had no effect. 3. Striatal and limbic dopamine release were elevated by cis- but not trans-flupenthixol. 4. The 'atypical' neuroleptics (clozapine and thioridazine) did not cause a selective elevation of dopamine release in the limbic terminal region, whereas the non-antipsychotic drug metoclopramide increased dopamine release more in striatum than nucleus accumbens. 5. We conclude from this study that striatal and limbic dopamine release are under the control of a stereoselective dopamine D2-autoreceptor on the nerve terminal and that atypical neuroleptics do not show a limbic-selective effect at this receptor after acute administration.

Partial cognitive-dysmnesic seizures as a model for studying psychosis

Nineteen patients were analyzed who exhibited cognitive-dysmnesic psychic partial seizures and structural damage shown by means of CT scans. It was observed that these seizures originated in the amygdala-hippocampal system, coinciding with the effects found when using electrical stimulation of the brain. An attempt is made to relate these findings to the present biochemical hypotheses of schizophrenia, the kindling effect and the genetico-maturational hypotheses. All these data seem to agree and point in the direction of the possible neurophysiological mechanisms of psychosis and of schizophrenia in particular.

Pathology, phenomenology and the dopamine hypothesis of schizophrenia

The dopamine hypothesis of schizophrenia implies that positive schizophrenic symptoms should be understandable by reference to brain structures receiving a dopamine innervation, or in terms of the functional role of dopamine itself. The basal ganglia, ventral striatum, septo-hippocampal system, and prefrontal cortex, sites of mesotelencephalic dopamine innervation, are examined and it is argued that their dysfunction could form the basis of particular schizophrenic symptom classes. The postulated involvement of dopamine in reinforcement processes might further assist such interpretations. This type of analysis can be extended to other categories of schizophrenic psychopathology.

Repeated atypical neuroleptic administration: effects on central dopamine metabolism monitored by in vivo voltammetry

Changes in extracellular DOPAC levels were monitored simultaneously in the nucleus accumbens and striatum of halothane/N2O anaesthetised rats using in vivo differential pulse voltammetry with carbon fibre electrodes following repeated administration of the atypical neuroleptics thioridazine and clozapine. Thioridazine (20 mg/kg s.c.) increased the DOPAC peak in the nucleus accumbens and striatum of rats treated with saline for the previous 21 days by 66% +/- 5 S.E.M. and 91% +/- 16 respectively. No such increase was recorded in the nucleus accumbens of rats previously treated with thioridazine (20 mg/kg s.c.) for 21 days. Similarly the increase in the striatum produced by a challenge dose on day 22 was markedly attenuated compared to controls although analysis of absolute DOPAC peak heights revealed extracellular DOPAC to be elevated above basal levels in this region (but not the nucleus accumbens) indicating a possible selective action of this drug to induce absolute tolerance to its acute effects in the nucleus accumbens after repeated administration. Administration of increasing doses of apomorphine (0.05, 0.1, 0.25 mg/kg s.c.) 1 h after a challenge dose of thioridazine (20 mg/kg s.c.) on day 22 to rats treated with the neuroleptic for the previous 21 days produced a progressive decrease in extracellular DOPAC levels both in the nucleus accumbens and striatum. Repeated administration of clozapine (50 mg/kg s.c.) for 21 days failed to induce tolerance to the acute effects of this drug, extracellular DOPAC levels increasing by 60% +/- 8 and 90% +/- 18 in the nucleus accumbens and striatum respectively following challenge with the drug on day 22.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute administration of clozapine, thioridazine and metoclopramide increases extracellular DOPAC and decreases extracellular 5-HIAA, measured in the nucleus accumbens and striatum of the rat using in vivo voltammetry

Changes in the extracellular levels of dihydroxyphenylacetic acid (DOPAC) and 5-hydroxy-indoleacetic acid (5-HIAA) after acute administration of clozapine (50 mg/kg s.c.), thioridazine (20 mg/kg s.c.) and metoclopramide (5 mg/kg s.c.), were monitored using in vivo voltammetry with micro-carbon electrodes implanted in the nucleus accumbens and striatum of the rat anaesthetised with halothane/N2O. Both clozapine and thioridazine increased extracellular levels of DOPAC in the striatum and the nucleus accumbens. The maximum increases with clozapine were 60% and 86% in the nucleus accumbens and striatum and 44% and 55% with thioridazine. Both neuroleptics also decreased the extracellular level of 5-HIAA in these regions of the brain. Metoclopramide increased the extracellular level of DOPAC in the nucleus accumbens (42%) and the striatum (57%) and significantly decreased the level of 5-HIAA in the nucleus accumbens. These results suggest that the two so-called atypical neuroleptics, clozapine and thioridazine, do not have selective effects on the metabolism of dopamine in vivo in the nucleus accumbens after acute administration. Furthermore, neuroleptic-induced increases in dopamine metabolism are accompanied by reciprocal decreases in 5-hydroxytryptamine metabolism in vivo.

Left globus pallidus abnormality in never-medicated patients with schizophrenia

Schizophrenia is a severe psychiatric disorder characterized by onset in young adulthood, the occurrence of hallucinations and delusions, and the development of enduring psychosocial disability. The pathophysiology of this disorder remains unknown. Studies of cerebral blood flow and metabolism designed to identify brain abnormalities in schizophrenia have been limited by inadequate methods of anatomical localization and the possibility of persistent medication effects. We have now used positron emission tomography and a validated method of anatomical localization in an attempt to identify abnormalities of regional cerebral blood flow in newly diagnosed never-medicated patients with schizophrenia. An exploratory study of 5 patients and 10 normal control subjects identified abnormally high blood flow in the left globus pallidus of patients with schizophrenia. A replication study of 5 additional patients and 10 additional control subjects confirmed this finding. No other abnormalities were found.

Regional distribution of the dopamine D2 receptors in the mesotelencephalic dopamine neuron system of human brain

Using the [3H]spiroperidol binding technique, we performed a regional distribution of the D2 receptors in the human mesotelencephalic dopamine neuron system. D2 receptors were found in decreasing order of concentration in caudate nucleus greater than putamen greater than nucleus accumbens greater than globus pallidus greater than amygdala greater than substantia nigra. D2 receptors could not be detected in any cortical region. The nigrostriatal and mesolimbic components of the mesotelencephalic dopamine neuron system are easily to reconstitute. If there exists a mesocortical component in man, its actions appear not to be mediated by D2 receptors.

An open multicentre study of the treatment of florid schizophrenia with remoxipride

Remoxipride, a novel substituted benzamide, was given for 4 weeks to 18 florid schizophrenics in an open study. The mental state of the majority improved as measured by the Brief Psychiatric Rating Scale. Remoxipride itself did not appear to cause troublesome extrapyramidal effects. There were no significant adverse effects on the cardiovascular system and no significant abnormalities in laboratory tests. These results suggest that remoxipride has antipsychotic effects, and that this should be tested in controlled clinical trials.

Presynaptic dopaminergic agonists modify brain glucose metabolism in a way similar to the neuroleptics

The effects of the (+) and (-) enantiometers of 3-(3-hydroxyphenyl)-N-n-propylpiperidine (3-PPP), 9,10-didehydro-6-methyl-8 beta-(2-pyridylthiomethyl)ergoline (CF 25-397) and 6,7-dihydroxy-2-dimethyl-aminotetralin (TL 99), three agonists of the postulated presynaptic dopamine receptor, on the pattern of brain glucose metabolism were studied using the autoradiographic technique of Sokoloff et al. [19]. It was found that these drugs modify brain glucose metabolism in a way similar to the neuroleptics but different from postsynaptic agonists. These results support the suggestion that these drugs could represent a new type of neuroleptic.

Clinical effects of apomorphine in schizophrenia

There have been reports that low doses of the dopamine-agonist apomorphine, which may inhibit dopamine neurotransmission, are of therapeutic benefit in schizophrenia. We conducted a placebo-controlled study of acute and chronic schizophrenics in which videotaped interviews were blindly rated. No specific therapeutic effect was demonstrated for apomorphine other than a reduction in anxiety in acute schizophrenics. Furthermore, there was no difference in the frequency of side-effects of apomorphine between schizophrenic patients and controls, and no specific effect of apomorphine on blink-rates. These findings emphasize the importance of placebo-controlled studies in schizophrenia research.

Central antidopaminergic properties of 2-bromolisuride, an analogue of the ergot dopamine agonist lisuride

2-Bromolisuride (2-Br-LIS), a derivative of the ergot dopamine (DA) agonist lisuride, was investigated in rodents in comparison with the DA antagonist haloperidol with regard to its influence on DA related behaviour, cerebral DA metabolism and prolactin (PRL) secretion. 2-Br-LIS produced catalepsy in mice (ED50 3.3 mg/kg i.p.), antagonized apomorphine-induced stereotypies in mice (ED50 0.4 mg/kg i.p.), antagonized DA agonist-induced stereotypies in rats (0.1-1.56 mg/kg i.p.), inhibited locomotor activity in rats (0.025-6.25 mg/kg i.p.), antagonized the hyperactivity produced by various DA agonists in rats (0.025-6.25 mg/kg i.p.) and inhibited the apomorphine-induced hypothermia in mice (0.05-0.78 mg/kg i.p.). 2-Br-LIS (0.03-10 mg/kg i.p.) stimulated DA biosynthesis and DOPAC formation in the striatum and DA rich limbic system of rats, but had no effect on serotonin turnover. In striatum and limbic forebrain of gamma-butyrolactone-pretreated rats 2-Br-LIS reversed the apomorphine-induced inhibition of DOPA accumulation. 2-Br-LIS (0.03 - 3 mg/kg) enhanced PRL secretion in intact male rats. These findings indicate DA antagonistic properties of 2-Br-LIS presumably due to blockade of central pre- and postsynaptic DA receptors being of approximately the same order of potency as haloperidol. 2-Br-LIS is the first ergot compound with definite antidopaminergic properties suggesting its potential usefulness as a neuroleptic.

Adverse effects of anticholinergic medication on positive schizophrenic symptoms

In a series of 36 patients with acute schizophrenia flupenthixol dosage was blindly adjusted to give a fixed level of sedation. Patients were than randomly allocated to procyclidine or placebo. The patients receiving procyclidine experienced more positive schizophrenic symptoms and less severe extrapyramidal features by comparison with placebo patients. Blood levels of prolactin and flupenthixol estimated by radioimmunoassay were not significantly changed by the addition of procyclidine. Flupenthixol dosage and levels and prolactin levels were significantly related. There was no significant association between clinical and laboratory measures, with the exception that a curvilinear (inverted U) relationship was demonstrated between flupenthixol levels and antipsychotic and extrapyramidal effects. This relationship may be due to the fact that, in a study of this design, patients resistant to the effects of neuroleptic medication are likely to be given the highest doses. The findings support earlier claims that anticholinergic medication has adverse effects on schizophrenic symptoms.

Dopamine and mania. The effects of trans- and cis-clopenthixol in a double-blind pilot study

Sordinol is composed of the mixture of cis-clopenthixol and trans-clopenthixol. The two isomers do not differ in several pharmacological properties, for instance anti-noradrenergic effect. However, cis-clopenthixol possesses anti-dopaminergic effects, while trans-clopenthixol does not. Sordinol-depot contains the almost pure cis-clopenthixol and appears to be less sedating than the oral and short-lasting intramuscular administration forms. In a double-blind pilot study with 10 manic patients, trans-clopenthixol was compared with cis-clopenthixol. Although not reaching statistical significance, cis-clopenthixol showed anti-manic effects, while trans-clopenthixol remained ineffective. It is concluded that the anti-dopaminergic effect of cis-clopenthixol is essential for its anti-manic effect, which is in agreement with the hypothesis of involvement of the dopaminergic system in the pathogenesis of mania.

The effect of the enantiomers of 3-PPP on conditioned avoidance responding in the rat

The effects of the enantiomers of 3-PPP on the maintenance of conditioned avoidance responding (CAR) were studied. The weak classical dopamine (DA) agonist (+)-3-PPP failed to interfere with CAR at any dose tested (0.8-13.6 mg/kg). Low doses of the drug produced sedation, while high doses produced behavioural stimulation. (-)-3-PPP, which acts as an antagonist on postsynaptic and as an agonist on autoreceptor DA sites, reduced avoidance with no effect on escape behaviour (6.8-13.6 mg/kg). However, this reduction of CAR occurred at doses much higher than those previously demonstrated to inhibit locomotor activity. This profile is discussed in relation to the behavioural effects of classical postsynaptic DA receptor antagonists.

Central dopamine receptor agonist and antagonist actions of the enantiomers of 3-PPP

The two enantiomers of the putative centrally acting dopamine (DA) autoreceptor agonist 3-(3-hydroxyphenyl)-N-n-propylpiperidine, 3-PPP (Hjorth et al. 1981), were pharmacologically evaluated. An extensive series of biochemical and behavioural experiments unexpectedly revealed that both (+)- and (-)-3-PPP showed clear, but differential, effects on the DA receptors. Thus, (+)-3-PPP is a DA agonist with autoreceptor as well as postsynaptic receptor stimulatory properties. In contrast, although (-)-3-PPP similarly activates DA autoreceptors it acts concomitantly as an antagonist at postsynaptic DA receptors. Moreover, both behavioural and biochemical data on motor activity and DA synthesis and turnover suggest a preferential limbic action for the (-)-enantiomer. These results are discussed in terms of the dual antidopaminergic action of (-)-3-PPP coupled with anatomical differences in the feedback organisation in central (viz, limbic vs striatal) DA systems. It is suggested that compounds like (-)-3-PPP may be of potential clinical utility in the treatment of psychotic disorders, whilst lacking the seriously incapacitating motor dysfunctions produced by current neuroleptic therapy.

The effect of niaprazine on the turnover of 5-hydroxytryptamine in the rat brain

Niaprazine (60 mg/kg i.p.) increased rat brain 5-hydroxyindole acetic acid (5-HIAA) concentrations 30 min after treatment, and reduced them at 3-8 hr after treatment. Rat brain 5-hydroxytryptamine (5-HT) levels were unchanged. Niaprazine also produced a short-lasting depletion of rat brain noradrenaline (NA) and dopamine (DA). Pretreatment with alpha-phenyl-alpha-propyl-benzeneacetic acid, 2-(diethylamino) ethyl ester hydrochloride (SKF 525A) (75 mg/kg i.p.) potentiated the increase in 5-HIAA and depletion of catecholamines produced 1 hr after niaprazine, but abolished the reduction in 5-HIAA produced 8 hr after the drug. This suggested that a metabolite might be responsible for the delayed reduction in 5-HIAA levels. A potential metabolite, p-fluoro-phenylpiperazine (FPP) (5-40 mg/kg i.p.) reduced rat brain 5-HIAA and 3,4-dihydroxyphenyl acetic acid (DOPAC), and inhibited 5-HT and NA uptake in vitro. Unlike niaprazine, FPP produced no behavioural sedation, but in large doses produced a behavioural syndrome indicative of serotonergic stimulation. Studies of the metabolism of 14C-niaprazine in rats indicated the presence of a urinary metabolite with the same chromatographic characteristics as FPP. These results suggest that niaprazine itself depletes brain catecholamines and increases 5-HT turnover, while a metabolite, FPP, subsequently reduces the turnover of 5-HT and DA.

Bromperidol, a new butyrophenone neuroleptic: a review

This review compares and contrasts the preclinical pharmacology of bromperidol with another butyrophenone neuroleptic, haloperidol, and the phenothiazine neuroleptic chlorpromazine. Its pharmacokinetics, biotransformation, and safety in several laboratory animal species are also summarized. These preclinical data support its use as an antipsychotic agent and show that it is well absorbed following oral administration with an apparent elimination half-life of approximately 24 h, supporting a once-daily dose regimen. Animal toxicity (including acute- and multiple-dose toxicology and reproductive and mutagenicity studies) show that bromperidol is well tolerated.

Regional blockade by neuroleptic drugs of in vivo 3H-spiperone binding in the rat brain. Relation to blockade of apomorphine induced hyperactivity and stereotypies

The regional prevention by neuroleptic drugs of specific in vivo 3H-spiperone binding was studied in the rat brain. L-sulpiride, thioridazine and clozapine was found to reduce the 3H-spiperone binding selectively in the olfactory tubercle, septum, substantia nigra region and frontal cortex but not the striatum at dose levels which preferentially block apomorphine (APO) induced hyperactivity. The maximal prevention of specific 3H-spiperone binding by l-sulpiride and clozapine reached 60-80% in the former structures while the displacement of striatal 3H-spiperone binding did not exceed 40%. In contrast to l-sulpiride, thioridazine and clozapine both chlorpromazine and haloperidol reduced the 3H-spiperone binding to the same extent in all regions studied. Chlorpromazine and haloperidol were potent in prevention of striatal 3H-spiperone binding in vivo which reached 60-80% in this structure.